Retrograde Ejaculation & Anejaculation: Causes and Fertility
This article is part of our guide on Male Fertility in Chennai — see the full treatment overview, success rates, and costs.
Orgasm With Little or No Semen
Some men notice that they reach climax, but little or no semen comes out. This can be alarming, and it is often only noticed when a couple has difficulty conceiving. The two main explanations are retrograde ejaculation and anejaculation. Both are recognised causes of male infertility, and in both cases the sperm-producing testicles are often working normally, so there are effective ways to help couples conceive.
This article is for education only. Please see a qualified urologist or fertility specialist for diagnosis and treatment.
What Is Retrograde Ejaculation?
During ejaculation, the muscle at the neck of the bladder normally closes so semen can only travel outward. In retrograde ejaculation the bladder neck does not close firmly enough, so some or all of the semen flows backward into the bladder and is passed out later with urine.
The sensation of orgasm is usually unchanged, which is why it is called a "dry orgasm". It is painless and it does not affect erections.
Retrograde ejaculation vs anejaculation
- Retrograde ejaculation: semen is made and released, but goes into the bladder. Sperm can be found in the urine afterwards.
- Anejaculation: semen is not expelled at all. The emission or ejaculation reflex has failed, so there is nothing in the urethra or the bladder. Causes include spinal cord injury, nerve damage from pelvic surgery, some medicines, and psychological factors.
The distinction matters because the test and treatment plan differ.
Symptoms
- A dry orgasm, or only a few drops of semen
- Cloudy or milky urine after climax
- Difficulty conceiving, often the first reason a man is tested
Causes
The bladder neck is controlled by nerves of the sympathetic nervous system. Anything that damages those nerves or the muscle itself may cause a problem.
- Diabetes. Long-standing, poorly controlled diabetes can damage the nerves that control the bladder neck. If you have diabetes, good control matters for many reasons, fertility included. See is infertility curable?
- Surgery on the prostate, bladder neck or pelvis, including prostate surgery, and lymph node surgery done for testicular cancer
- Medicines, especially alpha-blockers used for prostate symptoms or blood pressure, and some antidepressants and antipsychotics
- Neurological conditions and spinal cord injury, such as multiple sclerosis or Parkinson's disease
- Congenital differences of the bladder neck (uncommon)
How It Is Diagnosed
History and examination
Your doctor reviews your medicines, surgeries and medical conditions such as diabetes, and examines you.
Post-ejaculation urinalysis
This is the key test for retrograde ejaculation.
- Empty the bladder before producing a sample.
- Masturbate to climax in the clinic.
- Immediately pass urine into a sterile container.
- The lab spins the urine in a centrifuge and looks for sperm under the microscope.
A large number of sperm in the urine confirms retrograde ejaculation. Other tests, including a routine semen analysis and hormone tests, help exclude an ejaculatory duct blockage or testicular problems such as azoospermia.
Treatment
If you are not trying to conceive and the condition does not bother you, treatment is not needed. If it does bother you, or you want to have a baby, the options depend on the cause.
Medicines
Where the bladder neck is structurally intact, drugs that stimulate the bladder neck to close, such as pseudoephedrine, imipramine or midodrine, may restore forward ejaculation in some men. They must be prescribed and monitored by a doctor because they have side effects and are not suitable for everyone.
Adjusting causes
If a medicine is responsible, your doctor may be able to change it. Diabetes control should be optimised.
If medicines fail
When the bladder neck has been damaged, for example after surgery, medicines are much less likely to work. Sperm recovery and assisted reproduction are then the reliable route.
Fertility Treatment Options
Because sperm production is often normal, retrograde ejaculation is considered one of the more treatable forms of male infertility.
Sperm recovery from urine
Urine is acidic and can damage sperm, so the laboratory takes precautions:
- Alkalinising the urine. You may be asked to drink fluids and take sodium bicarbonate the day before and on the morning of the procedure.
- Collecting and processing quickly. The post-orgasm urine is collected in a container with culture medium, then spun in a centrifuge and washed in the embryology laboratory to remove urine.
- Preparing the sperm for IUI or ICSI.
IUI
If enough good-quality motile sperm are recovered, they can be placed directly in the uterus around ovulation. Read the IUI treatment process.
IVF with ICSI
When the recovered sperm are few or of reduced quality, or when there are other fertility factors, ICSI is often preferred. A single selected sperm is injected into each mature egg. See when ICSI is recommended and my ICSI treatment page. The recovery and preparation of sperm is handled in the IVF laboratory, where I work alongside the embryologists.
Surgical sperm retrieval
If urine-derived sperm are not usable, sperm can be retrieved from the testicle by TESA, a fine-needle procedure, and used with ICSI. Sperm collected this way are typically immature and non-motile, so ICSI is required. Read TESA and micro-TESE explained and see my TESA and micro-TESE service.
Anejaculation
For anejaculation, specialists may use vibratory stimulation or electroejaculation, sometimes with medicines, to obtain semen. If these do not work, surgical sperm retrieval and ICSI are options. Each approach is chosen after assessment of the cause.
Looking at the Whole Couple
The female partner's age, ovarian reserve, tubes and ovulation determine whether IUI is enough or IVF is a better route. See fertility treatment from trying naturally to IVF and age-related fertility decline.
If you or your partner have noticed dry orgasms, cloudy urine after climax or difficulty conceiving, an early evaluation can save time. Learn more about my male fertility care, or book a consultation with Dr. Rukkayal Fathima in Chennai. Your visit is confidential and unhurried.
Medical disclaimer: this article is general information and does not replace individual medical advice. Please consult a qualified specialist before starting or stopping any medicine.
Dr. Rukkayal Fathima
MBBS, MS (OBG), MRCOG (UK), FRM (Kiel University)
Fertility Specialist, Obstetrician, Gynecologist & Laparoscopic Surgeon
Dr. Rukkayal Fathima is one of India's leading Gynaecologists and the best fertility doctor in Chennai. She has 12+ years of experience and treated 3000+ patients. She specialises in IVF, ICSI, TESA/Micro TESE, IUI, Early Pregnancy Scan, Menopause advice, and Gynaecological surgeries. She is a Co-founder & Director of Yaal Fertility and Women's Centre, the Best Fertility Center in Chennai.
Have Questions About Male Fertility?
Every situation is unique. Dr. Rukkayal Fathima provides personalised, evidence-based guidance across multiple locations in Chennai.
Frequently Asked Questions
Yes. Sperm production is usually normal, and the sperm are simply passing into the bladder. Natural conception is unlikely because semen does not enter the vagina, but sperm can often be recovered from urine after ejaculation and used for IUI or IVF with ICSI. If urine-derived sperm are not usable, sperm can be retrieved surgically.
No. Semen in the bladder does not harm the bladder or kidneys and is passed out with the next urine. Treatment is needed only when you are trying to conceive or the condition is causing distress. It is still worth being examined, because the underlying cause, such as diabetes, should be identified.
The first urine passed after climax may look cloudy or milky because it contains semen. Later urine returns to normal.
It depends on the cause. If a medicine is responsible, changing it under your doctor's guidance may fix the problem. Mild nerve-related cases may respond to medicines that tighten the bladder neck. When the bladder neck has been damaged by surgery, the problem is often permanent, and fertility treatment is used to achieve a pregnancy.
In retrograde ejaculation, semen is produced and released, but flows backward into the bladder. In anejaculation, semen is not expelled at all because the emission or ejaculation reflex fails, so there is no semen in the urethra or the bladder. The tests and treatments differ.
Consult Dr. Rukkayal in Chennai
Available at 4 fertility clinic locations across Chennai. Walk-ins welcome; appointments preferred.
No. 747, Poonamallee High Road, Alagappa Nagar, Kilpauk, Chennai – 600 010
No. 149/1, Luz Church Road, Bhaskarapuram, Mylapore, Chennai – 600 004
No. 95, Plot No. 1, Velachery Main Road, Devi Karumariamman Nagar, Pallikaranai, Chennai – 600 100
Dr. Rukkayal is also a visiting consultant at Apollo Hospital, Motherhood Hospital, Cloud Nine Hospital, MGM Hospital, Metha Hospital and St. Isabel Hospital in Chennai. View all clinic locations
